Shivers and Sweats

Ian Glynn

Mark Honigsbaum is fascinated by fever trees. The phrase may bring to mind ‘the great, grey-green, greasy Limpopo River, all set about with fever trees’. But Honigsbaum is not interested in Kipling’s trees, or in the beautiful flat-topped acacias of the Kenyan rift valley, which are called ‘fever trees’ because they grow in malarial districts. What he writes about are the many species of Cinchona that grow at high altitudes on the inaccessible eastern slopes of the Andes, in Bolivia and Peru and Ecuador and Colombia and Venezuela, whose bark is the source of quinine.

It is well known that quinine is what makes tonic water bitter, and that it has been used both to protect against and to cure malaria. What is less well known is that quinine was (with the exception of the largely forgotten Chinese qing-hao) the first drug to be discovered that provided a specific cure for an infectious disease; and the disease it cured was both a serious cause of misery and death in many parts of the world, and a major barrier to European settlement in India, Africa and the Dutch East Indies.

The first drug designed to deal with a specific infection – the arsenical Salvarsan, used to treat syphilis before the days of penicillin – was developed by Ehrlich in 1909; the sulphonamides, including the celebrated M&B 693, arose as an offshoot of the synthetic dye industry in the 1930s; and the first antibiotics became widely available at the end of the Second World War. All these modern drugs were introduced to treat diseases that were well defined and known to be caused by particular organisms. When the Spaniards used cinchona bark to treat fevers in 17th-century Peru, no one knew what caused the diseases that were being treated. Indeed, the distinction between fevers that responded to the treatment and fevers that didn’t must have helped to define what we now think of as malaria.

Until recently, the accepted story was that in 1638 the beautiful Countess de Chinchón, wife of the Spanish Viceroy of Peru, was struck down by a vicious intermittent fever, with alternate chills and sweats, that seemed about to kill her. The Governor of Loja, who eight years earlier had barely survived a similar fever, recommended a native remedy that had saved his life; it had been suggested to him by a Jesuit missionary who had himself been cured by it. The remedy was an infusion made from the bark of trees growing high in the Andean rainforest above Loja, a bark the Indians called quinquina, or ‘the bark of barks’. The Viceroy took the Governor’s advice, and the Countess was saved. When she returned to Spain, the news of her miraculous cure sparked a healthy South American export trade in ‘Countess’s powder’ or ‘Jesuits’ bark’.

The story explains why, a century later, Linnaeus called the Loja tree Cinchona officinalis (immortalising the lady’s name but, by leaving out the first ‘h’, ensuring that the English always mispronounce it). The Viceroy kept a meticulous and detailed diary, which doesn’t mention his wife’s alleged illness, and there is good evidence that she never returned to Spain but died in Cartagena. It is possible that the husband rather than the wife was the patient, as the Viceroy did have repeated attacks of an intermittent fever – attacks which, by October 1638, had become so threatening that the Countess arranged a Mass for him, and distributed candles and alms throughout Lima. On 8 November he suddenly recovered, but there is no mention in the diary of the bark of a hitherto unknown tree. It is just conceivable that the Viceroy would have thought it impolitic to attribute his sudden cure to a native remedy rather than to the Mass and the alms.

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Letters

Ian Glynn ends his review of Mark Honigsbaum’s The Fever Trail (LRB, 25 July) with the claim that, owing to global warming, the malaria problem is ‘likely to grow worse and to spread to more temperate areas’. Most people, even in the United States, seem to have forgotten that malaria was once endemic throughout much of this temperate country. My grandmother remembered it as a plague on her riverside farm town in southern Idaho, and it was a scourge of the central Midwest – Indiana, Kentucky, Illinois, Kansas – in the 1850s. The promise of a territory free from malaria was one of the major incentives for settlement in northern states such as Minnesota. Idaho, and probably most other states, still have mosquitoes capable of carrying malaria. Heroic measures, and DDT, wiped out the disease for a few generations, but given global warming and the power of diseases to evolve beyond the reach of current treatments, we’d do well to remember that malaria is a disease that was beaten back here, not a disease that has not yet been known.